TL;DR
What licensure requires
Senior care licensure is a state matter, and so is any insurance requirement attached to it. Many states require a licensed assisted living or skilled nursing facility to maintain liability insurance as a condition of holding the license, and to file evidence of that coverage with the agency. Some prescribe a specific minimum limit. Others require insurance without stating an amount. Several impose no stated minimum at all.
Because the requirement is set separately in every state, and because facility categories are defined differently in every state, there is no national answer. What there is, reliably, is this: where a minimum exists, it is small.
Licensure minimums exist to ensure a licensed operator is not entirely uninsured. They were not set by reference to what a serious resident injury claim costs, and they have not generally been revisited against verdict trends. Meanwhile a HUD-insured lender, a REIT landlord, or a single case in a state with no cap on noneconomic damages will each require or produce numbers that bear no relationship to the statutory floor.
So treat the licensure requirement as what it is: a compliance task to satisfy and document. The question of how much limit to carry is answered elsewhere, from your own severity exposure, from the legal environment in the states you operate in, and from the requirements written into your loan and lease documents.
The state matters enormously for limit sizing, but through its liability law rather than through its licensure minimum. A state with a statutory private right of action carrying attorney fees produces higher claim frequency, because cases that would be uneconomic to bring elsewhere become viable. A state with no cap on noneconomic damages produces higher severity, because noneconomic damages are where essentially all the value of a senior care claim sits.
That comparison, rather than the licensure floor, is the useful one. It is set out state by state on the claim environment page.
Contact the agency that licenses your facility category in your state and ask for the current insurance requirement in writing. Two cautions. First, several states administer skilled nursing and assisted living through different agencies, so an operator holding both categories has two answers to obtain. Second, these provisions are amended more often than operators expect, so a requirement confirmed a few years ago should be reconfirmed rather than assumed.
Then file the evidence the agency asks for, on the schedule the agency sets, and keep the filing record. A lapse in the filing is a licensure problem even where the coverage itself never lapsed.
| State | Licensing agency |
|---|---|
| Alabama | State public health department, health provider standards bureau |
| Alaska | State health department, residential licensing and health facilities licensing |
| Arizona | Arizona Department of Health Services |
| Arkansas | Human services department, office of long term care |
| California | Department of Public Health (skilled nursing) and Community Care Licensing (RCFE) |
| Colorado | Department of Public Health and Environment, health facilities division |
| Connecticut | State public health department, facility licensing and investigations |
| Delaware | Health and social services department, division of health care quality |
| Florida | Agency for Health Care Administration |
| Georgia | Georgia Department of Community Health |
| Hawaii | State health department, office of health care assurance |
| Idaho | Health and welfare department, licensing and certification division |
| Illinois | Illinois Department of Public Health |
| Indiana | State health department, division of long term care |
| Iowa | State inspections and licensing agency, health facilities division |
| Kansas | Aging and disability services agency, adult care home licensure |
| Kentucky | Health and family services cabinet, office of inspector general |
| Louisiana | State health department, health standards section |
| Maine | Health and human services department, division of licensing and certification |
| Maryland | State health department, office of health care quality |
| Massachusetts | Department of Public Health (long-term care) and the elder affairs agency (assisted living certification) |
| Michigan | Michigan licensing agency for health facilities and adult foster care |
| Minnesota | State health department, assisted living and nursing home licensure |
| Mississippi | State health department, health facilities licensure and certification |
| Missouri | Missouri state health agency, Division of Regulation and Licensure |
| Montana | Public health and human services department, quality assurance division |
| Nebraska | Health and human services department, licensure unit |
| Nevada | Public and behavioral health division, health care quality and compliance |
| New Hampshire | Health and human services department, health facilities administration |
| New Jersey | New Jersey Department of Health, Division of Health Facilities Survey and Field Operations |
| New Mexico | State health department, division of health improvement |
| North Carolina | Division of Health Service Regulation |
| North Dakota | Health and human services department, health facilities licensure |
| NY | New York State Department of Health |
| Ohio | Ohio Department of Health |
| Oklahoma | State health department, long term care service |
| Oregon | Human services department, aging and people with disabilities |
| Pennsylvania | Department of Health (skilled nursing) and Department of Human Services (personal care) |
| Rhode Island | State health department, center for health facilities regulation |
| South Carolina | State public health agency, health facility licensing (recently reorganized) |
| South Dakota | State health department, office of licensure and certification |
| Tennessee | Tennessee Department of Health, Board for Licensing Health Care Facilities |
| Texas | Texas Health and Human Services Commission |
| Utah | Health and human services department, health facility licensing bureau |
| Vermont | Disabilities, aging and independent living department, licensing and protection division |
| Virginia | Department of Health (nursing) and Department of Social Services (assisted living) |
| Washington | State social and health services department, long-term support administration |
| West Virginia | State health facility licensure and certification office |
| Wisconsin | Department of Health Services, division of quality assurance |
| Wyoming | State health department, healthcare licensing and surveys |
Agency names are given so you know who to contact. This table deliberately carries no dollar figures: publishing an unverified statutory minimum would be worse than publishing nothing, and every figure has to be read at the current regulation before it goes on this site.
Last updated
Frequently asked
No. Many do require it as a condition of licensure and some prescribe a minimum limit, but the requirement, the amount, and whether any amount is specified vary substantially. Several states impose no stated minimum at all. Confirm the current requirement with the licensing agency for your state and facility category.
Because where they exist they are set far below what a lender, a landlord, or one serious claim would require. Clearing the minimum satisfies a filing obligation and says nothing about adequacy. The genuinely useful comparison is between what your program carries and what your loan and lease documents demand, and between your limit and your own severity exposure.
Often enough that a schedule compiled a few years ago should not be relied on. Licensure statutes and regulations in this area are amended regularly, and several states have made significant changes in recent years. Verify at the agency rather than from a secondary source.
Go deeper
Authoritative references
The federal requirements a certified skilled nursing facility operates under, including resident rights, quality of care, infection control, and resident personal funds.
How the survey process works, how deficiencies are scoped and cited, and what enforcement follows.
Neutral reference on insurance terms, admitted and surplus lines status, and state regulation.
Free coverage review
Send the declarations page and tell us your states. We will tell you whether the limit is defensible where you actually operate.